Remoção Cirúrgica de Caninos Maxilares Inclusos com Acesso Palatino e Manejo de Comunicação Naso-Sinusal

Abstract

This paper presents and discusses the complex surgical management of palatally positioned, impacted maxillary canines, highlighting structural principles of flap design, specific anesthetic strategies, perioperative neuroendocrine control, and the immediate resolution of any nasosinus communication. Case report: A 31-year-old systemically healthy female patient presented with impacted teeth 13 and 23; these were horizontally oriented and in close proximity to the nasal fossa, as diagnosed via cone-beam computed tomography. Under a strict protocol involving oral sedation (midazolam) and preemptive analgesia (codeine combined with paracetamol), deep selective maxillary anesthesia was administered using mepivacaine and articaine. A broad palatal envelope flap was raised, followed by osteotomy and odontosection to enable extraction with minimal mechanical trauma to the adjacent bone. During surgical luxation, a direct communication with the nasal fossa was identified; this was immediately stabilized using a lyophilized gelatin sponge and properly sealed via hermetic primary closure with 4-0 absorbable Catgut suture. The postoperative period was extremely favorable, showing absolutely no evidence of local infection or fistula formation. Final considerations: The complex palatal surgical approach to deeply impacted teeth always requires meticulous preoperative anatomical planning. The complete clinical success of this case relied heavily on the rigorous biological preservation of perilesional tissues, highly refined surgical closure techniques, and effective prophylactic pharmacological management of pain pathways, ensuring patient comfort and highly predictable tissue healing despite the significant challenges posed by a pneumatized maxilla.